MEDICARE: MR. PERMINDER SINGH PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	P160792833	WA

General Provider Information

NPI Number	:	1407369523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PERMINDER SINGH PTA

Provider Business Mailing Address
First Line	:	543 OVERLAKE DR E
Second Line	:
City	:	MEDINA
State	:	WA
Zip	:	98039-5326
Country	:	US
Telephone Number	:	253-229-2188
Fax Number	:

Provider Business Practice Location Address
First Line	:	543 OVERLAKE DR E
Second Line	:
City	:	MEDINA
State	:	WA
Zip	:	98039-5326
Country	:	US
Telephone Number	:	253-229-2188
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2017
Last Update Date	:	11/10/2017

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